Smith M C, Ghose M K, Henry A R
Am J Med. 1981 Jul;71(1):174-80. doi: 10.1016/0002-9343(81)90290-4.
Renal cholesterol embolization can occur spontaneously or as a complication of aortic surgery or major vessel angiography in patients with diffuse atherosclerosis. The demonstration of characteristic cholesterol crystals in tissue biopsy specimens is a pathognomonic finding. However, renal cholesterol embolism may be clinically diagnosed when renal failure develops after known inciting factors or together with systemic manifestations of atheromatous embolization such as lower extremity livedo reticularis, focal digital ischemia or retinal embolism. Previous investigators have emphasized the progressive nature of renal insufficiency due to cholesterol embolism, its poor prognostic significance and almost uniformly fatal outcome. In this report, we describe five additional patients with renal cholesterol embolization. In three of them only moderate renal insufficiency developed, and kidney function subsequently improved in all. In two patients the condition progressed to end-stage renal disease; one died with chronic renal failure whereas the other patient required four months of hemodialysis before kidney function eventually improved. Thus, cholesterol embolization may produce a spectrum of renal functional impairment. In some patients there is only a moderate loss of renal function with subsequent improvement; in others renal failure ensues. In this latter group, eventual return of kidney function can occur even after a prolonged period of renal insufficiency.
肾胆固醇栓塞可自发发生，或作为弥漫性动脉粥样硬化患者主动脉手术或大血管血管造影的并发症出现。在组织活检标本中发现特征性胆固醇结晶是一项具有诊断意义的发现。然而，当在已知诱发因素后出现肾衰竭，或伴有动脉粥样硬化栓塞的全身表现，如下肢网状青斑、手指局灶性缺血或视网膜栓塞时，可临床诊断为肾胆固醇栓塞。既往研究人员强调了胆固醇栓塞所致肾功能不全的渐进性、其不良的预后意义以及几乎一致的致命结局。在本报告中，我们描述了另外5例肾胆固醇栓塞患者。其中3例仅出现中度肾功能不全，随后所有患者的肾功能均有所改善。2例患者病情进展至终末期肾病；1例死于慢性肾衰竭，而另1例患者在肾功能最终改善前需要进行4个月的血液透析。因此，胆固醇栓塞可能导致一系列肾功能损害。在一些患者中，仅出现中度肾功能丧失，随后有所改善；而在另一些患者中，则会发生肾衰竭。在后一组患者中，即使在长期肾功能不全后，肾功能最终也可能恢复。
